SAMJ FORUM
BOOK REVIEW

Healers, helpers and hospitals (volumes 1 and 2)

Chief Specialist Scientist, South African Medical Research Council

The Anglo-Boer War (1899 - 1902) was intended by the British to be a short campaign, over in a matter of weeks, and aimed at putting the pesky Boer republics in their place. The fact that it lasted considerably longer was not the only unpleasant surprise for the Imperial Forces. Confronted by hostile geography and environment, and an unconventional and highly determined enemy fighting force, they were to lose many thousands of their troops, more from disease than from battlefield injury. Typhoid fever, dysentery, malaria and Dengue fever took a big toll of the troops on both sides. The British army was further confronted by trench warfare and guerilla warfare tactics, and by direct inclusion by the burghers of civilians in their offensives. The colonial war was deeply unpopular with a number of Britain's traditional allies and neighbours, notably France, The Netherlands, Germany and Russia, inviting wide condemnation. The Boers, too, were to lose a substantial number of their own troops.

The author of this two-volume history of military medicine in the war, J C (Kay) de Villiers, maintains that the Anglo-Boer War has largely been forgotten. Nonetheless, its consequences had a profound influence on subsequent South African history, up to the present time, notably on the Act of Union in 1910 and on the entrenchment of racially discriminatory laws that were attached to it. It was the first military conflict to put the Geneva Convention to thorough testing. The civilian concentration camps adumbrated even more horrifying examples in the 20th century. Medically, there was the first use of radiology in warfare and early application of surgical specialisation, anaesthesia, immunisation (against typhoid), use of diagnostic pathology laboratories, and prevention and treatment of surgical sepsis. Highly mobile field-based medical care was introduced by both sides.

Drawing upon more that 3 000 sources of information, including memoirs, diaries, letters, medical articles, press reports, poems, books, official reports and university dissertations de Villiers has compiled meticulously this account from both the Boer and British perspectives. In doing so he has been scrupulously fair and admirably non-judgemental. He is not above adding a little gossip or gentle ironic humour when it adds to the story. No detail is too small. There are people mentioned in the book, some with a biographical note, who, were they alive, would be amazed that they had gained a place in the history of the war. This medical history is the work of a clinician who has applied meticulous attention to the story.

The author makes it clear that a medical history of the concentration camps falls outside the scope of the current work. One can hardly argue with that, given the more than 1 100 pages of the two volumes. But his strict avoidance of the subject leaves a hiatus in one's understanding of the full medical impact of the war. Moreover, there is scant mention of black people in the book. From the little that is said it seems clear that hospital apartheid was already well in place. Reading the book requires stamina — it is extraordinarily comprehensive. A basic knowledge of the war on the part of the reader is assumed.

The result of Kay de Villiers' efforts, persistence and thoughtfulness is a permanent and irrefutable record. It is enhanced by many beautifully produced photographs. At least from the perspective of the medical record there is now no chance that the war will be forgotten. For that reason alone, we owe him a huge debt.